ICYMI: How can Canada get the international students it needs for the jobs it has? A new report calls for a ‘course correction’

Somewhat amusing, as all such reports say “Canada should do more,” with less discussion of trade-offs and relative effectiveness of existing programs. Addition is always easier than subtraction for governments and advocacy groups.

Not sure how a wage-subsidy program for international students, even in high demand fields, would be received by the Canadian public.

And more fundamental questions remain regarding international students and immigration pathways remain, not only with respect to study areas but also the type of institution (university, college, private), as others have noted:

Canada needs to do a much better job of targeting and supporting international students in order to deal with this country’s specific labour shortages — such as the recent “wake-up call” in health care — a new report says.

While foreign students are well-represented in STEM and business administration, their numbers need to go up in health care, some trades and services to meet Canada’s future labour market needs, says the report from RBC Economics & Thought Leadership.

Tweaking immigration selection to favour international students with a background in STEM, health care and in trades, and providing these students more work-integrated learning opportunities through co-ops or internships would go a long way, the researchers say.

Getting a Canadian education and work experience has increasingly become the pathway to permanent residence for many newcomers.

Every year, about 17 per cent of all new permanent residents and almost 40 per cent of immigrants in the economic category — newcomers chosen for their job skills and education — have studied in Canada.

However, a lack of networks and relevant work experience have been the primary barriers keeping some from finding a related job after they graduate, according to the report Course Correction: How international students can help solve Canada’s labour crisis.

Of the international students who have started studying in Canada since 2010, about one third later successfully acquired permanent residence. Migrating to Canada through the student pathway is an expensive route, with international tuition fees in universities averaging $33,000. “For many, a Canadian education may not yield the desired return on investment,” the report cautioned.

“We need to do more than just stamping a study permit and saying, ‘Figure it out on your own and we can’t wait to see you on the other side.’ There needs to be better collaboration and better support from start to finish,” says Ben Richardson, the report’s co-author.

“The international student cohort can be a very productive source of future immigrants and citizens to Canada, but we need to ensure that the variety of stakeholders … working in this space are working together.”

Richardson said Canada has done a lot of things right in attracting international students, by offering them postgraduate work permits for as long as three years and pathways for permanent residence based on the Canadian work experience they acquire.

Those policies have helped make Canada an international education powerhouse, surpassing the United Kingdom and becoming the third most common destination for international students behind the United States and Australia.

Enrolment of international students at Canadian post-secondary institutions has grown from 7.2 per cent in 2010 to almost 20 per cent of the overall enrolment in 2020.

Enrolment in short-cycle post-secondary programs, which can be as short as eight months, in colleges has notably grown twice as fast as other programs since 2016, as it’s viewed as a fast-track for immigration, said the report.

“Canada needs college-educated students to address labour shortages across the economy. But some students in short-cycle programs have a longer route to the labour market and permanent residency, and some may not have a path at all,” noted the report.

“With colleges now taking in 40 per cent of Canada’s post-secondary international students, versus 24 per cent in 2010, their admission choices are material to Canada’s foreign talent pipeline.”

While many colleges and universities are working with employers and governments to create training and bridging programs to meet changing labour market needs, the report calls for a more “concerted policy shift” to narrow the skills gap.

Getting international students to stay often hinges on what happens as school ends and they set their eyes on the pathways to careers and permanent residence.

“Almost all the countries that compete directly with Canada, whether it is the UK, the U.S. and Australia, they’re all raising their game and new competitors, such as India, Singapore and China, are looking to attract these same students,” says Yadullah Hussain, the study’s other co-author.

“So, how do we, from a place of strength, improve and upgrade the policies that we have?”

During the pandemic, the federal government prioritized immigration processing for international students and temporary residents in selected jobs through special measures, the report said.

These changes in selection criteria not only help serve Canada’s labour market needs but also inform prospective international students about where the country’s priorities are when choosing their fields of study.

The U.K., U.S. and Australia have already made plans to target STEM students to make it easier for them to enter and stay in those countries.

The report recommends Canada invest in a wage-subsidy program for international students in high-demand fields and ease their access to work-integrated learning, exempting them from additional work permits for co-op terms and internships.

“We’re operating from a position of strength, but we can’t take that for granted and rest on our laurels,” said Richardson.

Source: How can Canada get the international students it needs for the jobs it has? A new report calls for a ‘course correction’

Members of some diaspora communities call for Canada to break ties to Crown

Shallow reporting, with very limited number sampled with no understanding of the complications involved, with the exception of Carleton professor Jonathan Malloy.

More thorough reporting needed:

Some Canadians from diaspora communities called for the country’s independence from the Crown on Friday, saying the death of the Queen is a chance to rethink its ties to the monarchy.

More than 50 countries with historical links to Britain are part of the Commonwealth, which Queen Elizabeth II was head of throughout her reign. Her death Thursday came as a growing number of nations debate their relationship with the British Crown amid demands that the country apologize for its colonial-era abuses and award its former colonies slavery reparations.

Parmod Chhabra, the president of the India Canada Association, said he respected the Queen as the sovereign of Canada but thinks it’s time for the country to break ties with the Crown.

“I think it is the time for the monarchy to go away,” said Chhabra, recalling atrocities committed against Indians when the British Empire ruled that country.

“We should start rethinking about it, and think about total freedom, instead of having the Queen as our head whom we don’t elect,“ he added.

That sentiment was shared by Monir Hossain, the president of the National Bangladeshi-Canadian Council, who said Canada should be a fully independent nation like other countries around the world.

“I think we all want independence these days,“ he said. ”The world is moving forward.” 

The Royal Family has faced multiple controversies this year surrounding the Crown’s continuing role in Britain’s former colonies as members travelled to celebrate the Queen’s Platinum Jubilee, which marked her 70 years on the throne.

In March, Prince William and the Duchess of Cambridge were sharply criticized for being “tone deaf” and perpetuating images of Britain’s colonial rule during a tour of Belize, Jamaica and the Bahamas.

Though many people welcomed the royals, they were also greeted by protesters demanding an apology for Britain’s role in the enslavement of millions of Africans and reparations for the damage caused by slavery.

The following month, the Earl and Countess of Wessex — Edward, the youngest son of the Queen, and his wife Sophie — postponed the Grenada leg of a Caribbean tour on the eve of the seven-day trip after consultations with the Grenadine government and the governor general, the Queen’s representative on the island.

They had been likely to face similar calls for a British apology during their planned visit to Grenada, where activists had requested an audience with the royal couple.

Barbados cut ties to the monarchy in November and Jamaica has said it will follow suit.

In Canada, the Queen’s death will likely fuel conversations about getting rid of the monarchy, as well as responses that the country’s system works well and would be too hard to change, said Jonathan Malloy, a political science professor at Carleton University.

“The Queen’s longevity has allowed us to perhaps put off some conversations,” and some will see her passing as an opportunity for change, he said Friday.

The monarchy is anachronistic and represents values that no longer align with Canada’s direction, but the system “does actually work fairly well … and it would be extremely hard to change,” he said.

For instance, the Crown is at the heart of our legal and political systems, and cutting ties with it would, among other things, undermine treaties with Indigenous nations, he said.

Provinces probably also like the current system because it allows them to claim their own direct relationship with the Crown, and changing that would require them to overhaul their systems, Malloy said.

There would also be issues related to how to select a new head of state, and the risk that removing the Crown would open the door to other attempts to change the Constitution, he said.

“No government wants to be consumed by constitutional talks and changes,” he said, pointing to the constitutional crises of Meech Lake and Charlottetown several decades ago.

Not everyone in the diaspora community criticized the Queen and the British monarchy on Friday.

Reuben Wong, 73, who grew up in poverty in Hong Kong before immigrating to Canada in the 1970s, said he wouldn’t be where he is today without the Queen and the British system.

Hong Kong has not been a part of the Commonwealth since the 1997 handover to China, but some in its diaspora in Canada continue to embrace the monarchy.

“The Queen’s spirit lives in my blood,” the Richmond, B.C., retiree said Friday.

Wong said he grew up in a village with no water or electricity, and paid tribute to the free education provided by colonial British authorities that allowed him to immigrate and forge a career as a public servant. 

“When I look back, I feel thankful to the British system in Hong Kong and the Queen,“ he added.

Source: Members of some diaspora communities call for Canada to break ties to Crown

Serwer: The Right to Free Speech Is Not the Right to Monologue

Good and thoughtful commentary:

In august, the author Salman Rushdie was stabbed in the neck. The novelist has spent decades living under the threat of a hit put out by Ayatollah Ruhollah Khomeini in 1989. The religious directive was a response to Rushdie’s novel The Satanic Verses, which Khomeini regarded as blasphemous. For many, the attack was an opportunity to reflect on the importance of free expression, and a reminder of the clear distinction between speech and violence.

For others, it was an opportunity to remind others of the clear distinction between speech and violence, which is something that all those snowflake libs, who are sort of like the fanatic who stabbed Rushdie in the neck, should take to heart.

“We live in a culture in which many of the most celebrated people occupying the highest perches believe that words are violence,” Bari Weiss wrote on her Substack, citing no one in particular. “In this, they have much in common with Iranian Ayatollah Ruhollah Khomeini.” She added that “of course it is 2022 that the Islamists finally get a knife into Salman Rushdie. Of course it is now, when words are literally violence and J.K. Rowling literally puts trans lives in danger and even talking about anything that might offend anyone means you are literally arguing I shouldn’t exist.”

As an outlet, The Atlantic attempts to provide readers with a broad spectrum of perspectives based on shared values. One of these values is freedom of speech, a principle to which I and all of my cherished colleagues are deeply committed. The assassination attempt on Rushdie was a direct attack on that freedom, and it should be no surprise that writers here have a great deal to say about it. But I must respectfully disagree with some of my colleagues about the conclusions they have drawn from the attack, linking contemporary left-wing discourse with a fundamentalist theocrat’s call for assassination.

My colleague Graeme Wood pointed to Jimmy Carter’s 1989 op-ed criticizing Rushdie to argue that “over the past two decades, our culture has been Carterized. We have conceded moral authority to howling mobs, and the louder the howls, the more we have agreed that the howls were worth heeding.” He acknowledged, however, that “since the attempt on Rushdie’s life, almost no one has advanced these arguments,” meaning a link between the emotional injury of blasphemy and the very literal violence of murder. If our society were truly “Carterized,” I would have expected instead to have seen some prominent American figures make the argument Carter did decades ago.

Another one of my colleagues, Caitlin Flanagan, settled for an exegesis of the views of the Twitter user @MeerAsifAziz1, whose account no longer exists. She argued that “the culture of free speech is eroding every day,” and offered a hypothetical example: “Ask an Oberlin student—fresh outta Shaker Heights, coming in hot, with a heart as big as all outdoors and a 3 in AP Bio—to tell you what speech is acceptable, and she’ll tell you that it’s speech that doesn’t hurt the feelings of anyone belonging to a protected class.”

I’ll make no secret that I believe the focus on the misguided egalitarianism of undergraduates at private colleges has been disproportionate. People like this exist, though, and it’s fair to criticize them. What I frankly find puzzling is presenting this hypothetical student as the avatar of the idea that dangerous speech and ideas must be suppressed, when in statehouses and governors’ mansions, politicians who have the authority to enforce their ideas about censorship with state power are actually putting them into practice. Unlike the hypothetical Oberlin student, these officials are real, and the threat they pose to free speech is not only clear and present, but backed by a certain level of popular demand.

I agree with Weiss and Wood and Flanagan that there is a bright line between speech and violence that must be respected, and that trying to kill someone for offending you is monstrous. Speech is not violence, and to argue so is to imply that violence is an appropriate response. The unacknowledged reality of these three essays, however, is that what I just stated remains the broad, widely held consensus in American life, from right to left. Americans simply do not live under anything resembling the kind of repression in which people are killed for blasphemy with state or popular support.

Weiss, Wood, and Flanagan also noted the objection of a group of writers and thinkers to the PEN association bestowing an award on Charlie Hebdo, the French satirical publication that terrorists attacked in 2015 over its caricatures of the Muslim prophet Muhammad, murdering 12 people, including several staff members, police officers, a maintenance worker, and someone who was visiting that day. The letter signers described the massacre as “sickening and tragic” while criticizing PEN for “valorizing selectively offensive material: material that intensifies the anti-Islamic, anti-Maghreb, anti-Arab sentiments already prevalent in the Western world.”

Weiss attacked the “civic cowardice” of those who objected, while Flanagan wrote that these writers were pressuring the organization to “abandon its mission” of protecting freedom of expression. Wood described the writers’ position as muddling “the distinction between offense and violence, and between a disagreement over ideas and a disagreement over whether your head should remain attached to your body.”

I would not have signed that letter if asked, not only because I do not sign open letters, as a matter of preference, but because I believe that blasphemy is a human right, and that the message that PEN was sending with the award was an endorsement not of Charlie Hebdo’s content but of the staff’s bravery in the face of an attempt to silence them through murder. But just as I have no objection to the award, I have no issue with people criticizing it because they do not want it to be interpreted as an endorsement of the racist caricatures Charlie Hebdo is known for, even accepting that they are intended with a layer of irony. (I’m not sure how many of the people disseminating these images are aware of the irony.) These may be mutually exclusive positions, but both are consistent with respecting free speech. Indeed, both the writers of the letter and its critics are arguing that there are things you can say but should not.

One of the significant measures of free speech in a given society is how people deal with blasphemy—whether religious offense provokes state censorship or violence. America has a relatively strong record in that respect in comparison with much of the rest of the world, while clearly faltering in others. The suggestion here, however, is that the writers who objected to the award granted to Charlie Hebdo are in some sense justifying the massacre, and therefore defending the notion that violence is an appropriate response to offensive speech. But surely one can defend the right of Nazis to publicly protest while rejecting the tenets of national socialism. If I cannot defend the fundamental right of a speaker to be offensive while objecting to their speech, then what am I actually defending?

In this case, the rights being asserted seem to be the right to be offensive, and the right of the offended to shut up and like it. The former combined with the latter is not an assertion of the right to free speech so much as a right to monologue, which I do not recognize.

The American culture of free speech is indeed under threat, as Flanagan argued. Free speech requires a robust exchange of views without the coercion of threats and violence, and self-censorship in response to social pressure is a genuine risk. Yet by definition, there is no free speech if one person is allowed to make an argument and another is not allowed to object to it. Nor has there ever been a time in American history when freedom of speech was not threatened with proscription by the state, or when one could express a controversial opinion and not risk social sanction. In short, the culture of free speech is always under threat.

In almost every era of U.S. history, the bounds of free expression have been contested. In the founding era, patriots tarred and feathered royalists. Before the Civil War, southern states passed laws that could be used to prosecute the dissemination of abolitionist literature and sought to prevent the Postal Service from delivering antislavery pamphlets, saying they would foment insurrection by the enslaved. Mobs followed the abolitionist Frederick Douglass across the North, throwing rotten eggs, stones, and menacing slurs at the orator at speaking events.  After Reconstruction, white supremacists destroyed the office of Ida B. Wells’s newspaper, The Free Speech and Headlight, following the publication of an editorial arguing that lynchings of Black men accused of raping white women were in fact punishment for consensual relationships. The Red Scares of the 20th century saw Americans forced from their jobs and prosecuted for leftist beliefs or sympathies on the grounds that those were tantamount to a commitment to overthrowing the government. Out of that crucible emerged a civil libertarian concept of free speech that many have mistaken for timeless rather than a product of a certain history and a particular arrangement of political power. The idea that certain forms of speech or expression justify or provoke violence, let alone that blasphemy does so, is not an invention of modern social-justice discourse.

Every generation faces a different challenge when it comes to freedom of expression. Ours includes not only the widespread and growing campaign of state censorship led by Republican lawmakers, but a social-media panopticon that can both deny us the privacy necessary to come to our own conclusions and inhibit the courage necessary to express them. Most of us are not meant to be privy to every misguided utterance of a stranger, nor are we meant to have our errors or worst moments evaluated publicly by people who learned of our existence only as the focus of political propaganda, as the subject of ridicule, or as acceptable targets in pointless feuds between online cliques. (Although it must be said, there are those who thrive in such conditions, and have successfully exploited them for fame, profit, and status.)

Yet, as Aaron R. Hanlon recently wrote in The New Republic, this wave of censorship laws in Republican-controlled states bears scant mention among many of the most prominent self-styled defenders of free speech, or at least, far less than the tyranny of the ratio. But we do not become little Rushdies when our inboxes and mentions are inundated with deranged filth from disturbed strangers, as a result of the public-facing profession we chose and the technological advancements that make us more accessible to such people.

It is not minimizing the power of digital mobs to say that spending decades with the state-backed threat of an assassin’s blade at your throat is coercion of a different magnitude. The wrath of an online mob can be harrowing: harassment, outrageous falsehoods, and threats are not pleasant to bear, and can threaten not just your mental health but your livelihood, and in extreme cases your safety. To pretend that seeking to avoid such an experience does not condition what people say and how they act would be foolish. But to pretend that this is a left-wing ideological phenomenon rather than a structural one, when educatorsmedical providerselection officials, and others from all walks of life are being driven underground by right-wing influencers who can conduct a mob like an orchestra, would be equally foolish.

The United States is living through the largest wave of state censorship since the second Red Scare. Beyond the plague of education gag laws restricting the teaching of unpleasant facts about American history, conservative judges seek to rewrite constitutional free-speech protections to punish the “liberal” media, and conservative states pass laws against public protest and immunize from liability those who would run over protesters with their cars, while law-enforcement organizations hope to use civil lawsuits to sue demonstrations against police brutality out of existence. Conservatives have sought to fire librarians and purge public libraries of books they deem controversial by categorizing them as obscene, as state officials try to punish teachers who provide their students with public information that allows them to access samizdat from libraries in states where it is not forbidden. Not only do abortion bounty laws seek to enforce silence around reproductive health, lest a person discussing the subject prick the ears of some snitch seeking a payday, but the overturning of Roe has coincided with explicit attempts to criminalize speech about abortion. In the strongest labor market in a generation, billionaires seek to use their power and authority to crush workers organizing for better conditions and a living wage.

There is no shortage of major free-speech issues to address in America today, but many of us in the writing profession are primarily concerned with our social-media experience, because that is what we most directly and frequently encounter. Instead of recognizing that the warped behavioral incentives created by social media are a structural problem, we tend to blame the people online who annoy us the most. In many cases, those defending “free speech” are not defending freedom of expression so much as seeking the power to determine which views can be publicly expressed without backlash, and which can be silenced without reproach. When we speak of an idealized past without chilling effects, we are simply imagining a time when the social consensus was repressive and stifling for someone else.

These conflicts are far more complex precisely because there is no clear line where social pressure from those exercising their rights of free speech and association crosses over into censoriousness. State censorship and violent compulsion are relatively easy to identify and oppose, if not always easy to prevent. When does accountability become harassment? When does protest become coercion? What views should be acceptable to state in polite society, and which should be appropriately shunned by decent people? When does a voice of criticism become the howl of a mob? When does corporate speech become corporate censorship? No society in human history has ever had simple answers to these questions. In a free society, sometimes people will choose to be horrible, and there is little to do other than make a different choice and counsel people to do the same.

Presenting these dilemmas as similar to an attempt to silence someone with a theocratic death mark is trivializing, and ahistorical. There has never been a golden age when anyone could say what they wanted without consequence, only eras in which one shared perspective was dominant. Though nostalgia may cloud our perceptions, those times were no more free, even if politics, ideology, or self-promotion might compel us to remember otherwise.

Source: The Right to Free Speech Is Not the Right to Monologue

Douglas Todd: The downside to increasing low-skill migration to Canada

Good overview of recent research on low-skill migration and the government’s repetition of the Harper government mistakes before correction after a few years:
Former Conservative prime minister Stephen Harper found himself in trouble in 2014 for jacking up the number of temporary foreign workers coming to Canada to work at places like McDonald’s and Tim Hortons.
Then-opposition leader Justin Trudeau, labour unions and the media went into overdrive — attacking Harper for pandering to the business lobby by inundating the market with hundreds of thousands of low-skilled temporary foreign workers, many of whom were vulnerable to exploitation.
To the surprise of many, Harper responded to the outcry. He sharply reduced the number of guest workers and brought in laws encouraging employers to improve working conditions and hire more people who were born in Canada or had become permanent residents.

Source: Douglas Todd: The downside to increasing low-skill migration to Canada

The Differential Impact of COVID-19 on Labour Market Outcomes of Immigrants in Canada

Another study on the differential impact of COVID on immigrants, recent and long-term, highlighting, as expected recent immigrants were most affected, followed by established immigrants. Conclusion below:

Our results indicate that the pandemic has had an obvious large adverse effect on a wide range of labour market outcomes for all workers in Canada. The adverse effects, however, have been particularly large for recent immigrants relative to the domestic-born as they experienced a disproportionately lower probability of being employed and of holding a full-time job, a higher probability of having only temporary work and substantially more unpaid overtime. When these disproportionate adverse effects for recent immigrants are added to the overall adverse effects for all workers, the magnitudes of the total adverse effects of the pandemic for immigrants are extremely large. The same applies to established immigrants. In essence, the overall workforce experienced substantial adverse effects of the pandemic, but those adverse effects were disproportionately large for recent and established immigrants.

Most of the effects of the pandemic were concentrated in the initial first wave as the shutdowns and social distancing forced consumers, employers, and workers to adjust immediately; however, recent immigrants continued to experience disproportionately negative labour market outcomes in later waves. Heterogeneous effects were also documented with greater adverse effects for recent immigrants relative to domestic-born who are women, who have child responsibilities and who are the less educated. Of particular note, recent immigrants working in occupations with greater exposure to COVID-risk reported increased employment and substantially more unpaid overtime than domestic-born during the pandemic.

The pandemic generally had different effects across the quantiles of the distribution of the outcomes for recent immigrants, relative to the domestic-born, with the differential adverse effects tending to be concentrated at the bottom of the outcome distributions. Although recent immigrants gain a small positive wage premium relative to the domestic-born at the bottom of the wage distribution, the benefits of this may be illusory if it reflects wage bonuses for COVID risks or low-wage workers more likely not to be employed. Recent immigrants at the bottom of the outcome distributions reported fewer weekly hours worked, fewer hours worked relative to scheduled hours, and more unpaid overtime than domestic-born workers. The hours differences could exacerbate inequality in hours worked between immigrants and the domestic-born for those working in precarious arrangement (i.e., few hours, large scheduling uncertainty, and more unpaid overtime hours).

While hazardous to suggest policy implications from such an unanticipated and still unfolding event as the pandemic, a number of policy considerations merit attention. The disproportionate adverse effect of the pandemic on more vulnerable disadvantaged recent immigrants (e.g., women, less educated, low-wage, those with childcare responsibilities and high exposure to COVID risk) should be recognized, and targeted rather than applying “one-size fits all” initiatives.8 Koebel et al. (2021), for example, argue that a basic income guarantee targeted toward low-income workers, in combination with Canada’s pre-existing Employment Insurance program, would have produced better employment and public health outcomes than the less targeted combination of the Canada Emergency Response Benefit and Canada Emergency Wage Subsidy that were used. Qian and Fuller (2020) emphasise the importance of enhanced child-care arrangements given the disproportionate adverse effect on women with child-care responsibilities.

Immigrants tend to face barriers in having their foreign credentials recognized and in acquiring occupational licenses and the associated wage gains that are disproportionately large for them (Gomez et al. 2015). Removing such barriers and relaxing occupational licensing restrictions can be a targeted initiative for immigrants (Gomez et al. 2015). The fact that the adverse effects tended to occur early in the pandemic highlights the importance of early intervention and having a playbook in place to facilitate an early response. Elements of a playbook for labour policy include: having a first-responder labour policy team in place; determining early the novel versus permanent nature of the shock; acting quickly but flexibly to make mid-course corrections if necessary; keeping people in their existing jobs to preserve firm-specific human capital; balancing active labour market policy versus passive income support; co-ordinating with other departments and jurisdictions; anticipating conflicts; and planning for the recovery with an exit strategy (Gunderson 2020). Lessons from this pandemic as well as previous shocks can be invaluable for preparing for future shocks.

Source: The Differential Impact of COVID-19 on Labour Market Outcomes of Immigrants in Canada

Does the federal government fund and support racially discriminating groups and individuals?

Drawing the contrast between the relative kid glove treatment of the “Freedom” Convoy and providing them a further platform in the Rouleau Commission:

Federal funding of hateful messaging has been in the news lately after Prime Minister Justin Trudeau condemned the comments of a senior consultant who was working on a federally funded anti-racist project. As a result of Laith Marouf’s anti-French and anti-Semitic postings, the $130,000 funding of the group, the Community Media Advocacy Centre, was suspended. This happened, despite the federal government apparently knowing about Marouf’s past.

Contrast that to the multi-million dollar federal Public Order Emergency Commission inquiry into the federal government temporary use of the 1988 Emergencies Act this past February to remove the Freedom Convoy protesters from downtown Ottawa.

Yet the Freedom Convoy group antics, which paralyzed Ottawa’s downtown core for more than three weeks this past January and February, forced authorities to spend millions of dollars in policing costs. The Freedom Convoy leaders are now wanting even more money than could be granted under Treasury Board guidelines and are asking for $450,000 of their $5-million in donations to be unfrozen, now held in escrow. This request may actually happen even though it’s a bit rich when such participation brings with it more propaganda for their disruptive causes.

In addition to the Rouleau inquiry giving the Freedom Convoy legal standing and funding, this federally funded commission is encouraging written submissions from Freedom Convoy supporters. The federally funded commission has made a point of encouraging Freedom Convoy supporters to make written submissions to it

The federal commission’s lead question on its website asks for those on side of the Freedom Convoy “protest” to describe their experiences. Those who were affected by the “protest” activities are asked secondarily to offer their experiences.

Rouleau is, in effect, placing the Freedom Convoy participants in an important, if not equal, position to those who were affected by the convoy, giving them more space and prominence than they deserve.

Canada’s Public Safety Minister Marco Mendicino, meanwhile, according to highly redacted cabinet minutes, saw the Freedom Convoy protesters falling into two categories: the “harmless and happy with a strong relationship to faith communities,” and the “harder extremists trying to undermine government institutions and law enforcement.” However, it seemed as if the police in Ottawa were siding with the Freedom Convoy protesters during February’s occupation.

Mendicino did not comment on the tacit mix and dynamics of the happy folks and extremists who occupied downtown Ottawa for more than three weeks.

Does this leave federal authorities less than neutral or too easy on the illegal activities of the Freedom Convoy participants? Do we not remember the federal government’s past racist actions with residential schools or the internment of Canadian Japanese citizens during the Second World War?

The federal government continues to mount ineffective anti-racist “campaigns” and decries anti-Semitic activities without taking action.

It’s also standing idly by when it comes to Quebec’s racist Bill 21 and its overt discrimination against minorities and those, for instance, who teach and wear hijabs being ousted.

The Freedom Convoy protesters appear to be treated as official interveners.

So let’s call the feds for what they are: a bunch of yellow-shrinking-stand-by con artists.

Ken Rubin founded the Ottawa People’s Commission to hear from residents about the harm incurred during last February’s Freedom Convoy siege in Ottawa, though the views expressed here are his own personal ones.

Source: Does the federal government fund and support racially discriminating groups and individuals?

Lien entre immigration et valeurs: Legault admet avoir manqué de prudence

Of note. An innocent gaffe or one that reveals his thinking?

Le chef caquiste, François Legault, a reconnu jeudi qu’il a manqué de prudence en faisant le lien entre l’immigration et les valeurs québécoises, au lendemain d’une déclaration qui a semé la controverse.

Lors d’un point de presse, M. Legault est revenu sur ses propos de la veille, qui ont plongé sa campagne dans l’embarras.

« Je ne suis pas parfait, a-t-il concédé. Tous les États dans le monde ont un défi d’intégration aux valeurs du pays ou de l’État qui reçoit. Maintenant, il ne faut pas nommer quelles valeurs parce que ça pourrait créer un amalgame. Effectivement, je n’aurais pas dû nommer de valeurs. »

Mercredi, François Legault avait justifié la décision de son parti de maintenir le nombre d’immigrants reçus à 50 000 personnes en faisant valoir que les défis posés par l’intégration pourraient compromettre certaines valeurs québécoises.

Il avait notamment mentionné le pacifisme et la laïcité, ajoutant que les Québécois n’aiment pas la violence ni l’extrémisme. Ces paroles ont été dénoncées par ses adversaires, qui y ont vu un dérapage et un amalgame dangereux.

Sujet délicat

Jeudi, M. Legault a affirmé qu’il aurait dû limiter son propos aux défis que pose l’intégration des immigrants en ce qui concerne la langue française.

« J’ai répondu aux questions sur les valeurs alors que c’est un sujet délicat que je devrais éviter, a-t-il dit. Mais quand on parle de langue, je pense que c’est une question fondamentale pour l’avenir de la nation québécoise. »

Dès le début de son point de presse, M. Legault a abordé la controverse soulevée par ses propos, qui l’ont forcé à se rétracter en fin de journée mercredi.

« Je n’ai jamais voulu associer l’immigration et la violence, a-t-il dit. Maintenant, ce que j’ai voulu dire, c’est que tous les États dans le monde ont un défi d’intégrer les nouveaux arrivants à leurs valeurs et à leur langue. Mais au Québec, c’est un défi particulier à cause de la situation de la langue en Amérique du Nord. C’est tout ce que j’ai voulu dire. »

Anglade rejette les excuses

La cheffe libérale, Dominique Anglade, a rejeté jeudi les excuses de M. Legault, qu’elle a accusé de perpétuer des préjugés. Elle a fait référence aux propos du chef caquiste au printemps, quand il a réclamé de nouveaux pouvoirs en immigration pour éviter au Québec d’être la prochaine « Louisiane ».

« Je ne le crois pas parce que c’est lui-même qui nous a entretenus de la question de la Louisiane et des enjeux de l’immigration, que c’était un problème, qu’il faut faire attention, a-t-elle dit. C’est lui qui entretient ça, et là, ce qu’on voit, c’est la véritable face de François Legault. »

Mettant en avant les valeurs d’inclusion et d’ouverture du Parti libéral du Québec, Mme Anglade a maintenu que M. Legault avait fait le lien entre l’immigration et la violence.

« François Legault a livré le fond de sa pensée, a-t-elle soutenu. L’autre, celui qui n’est pas comme nous, il peut être dangereux. Ça, ça continue à alimenter les préjugés. On n’a pas besoin de ça au Québec. »

Après avoir fait de l’économie l’enjeu principal de ces élections, Mme Anglade a affirmé que le scrutin se jouera aussi sur les questions de division ou d’inclusion.

« Nous, on a des valeurs d’inclusion, on a des valeurs de véritable développement économique moderne », a-t-elle dit.

Excuses publiques

Même si François Legault a corrigé le tir mercredi sur le réseau social Twitter en disant ne pas avoir « voulu associer l’immigration à la violence », le co-porte-parole de Québec solidaire Gabriel Nadeau-Dubois estime qu’il doit « s’excuser publiquement ». Le chef caquiste doit « répondre aux questions », a-t-il ajouté.

Ce sont « des déclarations qui alimentent les préjugés et détériorent le climat social », a-t-il souligné, en marge d’une annonce en habitation. M. Nadeau-Dubois a appelé le chef de la Coalition avenir Québec à considérer les immigrants comme des « êtres humains en chair et en os » et non comme des chiffres et des statistiques.

De son côté, le chef péquiste, Paul St-Pierre Plamondon, a voulu se placer au-dessus de la mêlée.

« Dans l’ensemble, c’étaient vraisemblablement des propos inappropriés, a-t-il dit. Mais il s’est excusé. Donc, j’en prends acte. J’invite tout le monde à mener une campagne axée sur l’avenir, mais qui a le potentiel de rassembler. »

Source: Lien entre immigration et valeurs: Legault admet avoir manqué de prudence

Martin: It’s not the economy, stupid. It’s the media

Good column, if depressing:

A major change in the communications system, Canadian media guru Marshall McLuhan opined long ago, “is bound to cause a great readjustment of all the social patterns, the educational patterns, the sources and conditions of political power, [and] public opinion patterns.”

Given the vast changes that have marked the digital age, McLuhan can hardly be accused of overstatement. The online world is corrosively altering social and political “patterns,” to use the McLuhan term, and destabilizing democracies.

In using internet platforms, fringe groups and hate generators have multiplied exponentially and contributed to an erosion of trust in public institutions. They’ve prompted violent threats against public officials, driven the United States into two warring silos, and cast a pall of negativity over the public square seldom seen.

The contamination of the dialogue is such that even agreement on what constitutes basic truths has come to be tenuous. Talk of a post-truth America is no joke. Canada isn’t there yet, but give the disinformation amplifiers more scope and we soon might be.

Bill Clinton’s campaign strategist, James Carville, may have had it right back in the 1990s when he famously declared why voters had soured on then-president George H.W. Bush: “It’s the economy, stupid.” But not today. Now it’s the media, stupid. It’s the upheaval in the communications system. A media landscape gone rogue.

Economic woes get regulated. Not so the convulsions in our information ecosphere. We have no idea how to harness the hailstorm. Few efforts are being made. Calls for regulation are greeted by a great hue and cry over potential freedom-of-speech transgressions.

So broadly has media influence and power expanded that a cable network has become the avatar of the Republican Party. Donald Trump has maintained support from the GOP because he has what Richard Nixon didn’t. A kowtowing TV network and a Twitter following, until he was blocked, of 90 million users.

Social media platforms, like an upstart rival sports league, have served to delegitimize, if not disenfranchise, traditional media, magnifying public distrust. There is still a lot of high-quality journalism around, including at this awards-dominating newspaper. But traditional media no longer set the tenor of the national discussion and help shape a national consensus as in times past. Enfeeble a society’s credible news and information anchors, replace them with flotsam and you get, as per the United States, a country increasingly adrift.

The trajectory of media decline is worth recalling. From having just two or three television networks in Canada and the U.S. that aired news only for an hour or so a day, we have expanded to around-the-clock cable networks. News couldn’t fill that much airtime so opinion did – heaps of it. Hours of tirades filled the airwaves from reactionaries like Rush Limbaugh. Then the internet took hold, along with the invasion of unfiltered social media, awash in vitriol.

And so the chaff now overwhelms the wheat.

Mainstream media got in on the act, lowering their standards, contributing to the debasement of the dialogue by running ad hominem insults on comment boards from readers who hide behind pseudonyms. As I’ve noted before, that’s not freedom of speech. That’s fraud speech.

The crisis in our information complex is glaring, but it isn’t being addressed. Mainstream media, while demanding transparency everywhere else, rarely applies this standard to itself. Despite its exponential growth in importance, the media industry gets only a small fraction of the scrutiny that other powerful institutions do.

Big issues go largely unexamined in Canadian media. We rarely take a critical look at the unfettered rise of advocacy journalism, the impact of the disappearance of local newspapers or media ownership monopolies. There are precious few media columnists in this country. There is no overarching media institute to address the problems.

Conservative leadership candidate Pierre Poilievre’s big idea is to deprive us of one of our longest-standing national institutions. He would gut the CBC, defund it practically out of existence. At his rallies, he’s cheered on lustily for the promise, an indication of the low regard held by many in the population toward the mainstream media.

Any kind of media-reform drive always runs up against the freedom of speech barrier. The Trudeau government has passed Bill C-10, but it was diluted and will have little regulatory impact. A Commission on Democratic Expression, whose membership included former Supreme Court Justice Beverley McLachlin, has recommended regulatory reforms to curb social media’s impact. But it didn’t receive anywhere near the attention it deserved.

There’s a vacuum. Ways to regulate the destabilizing forces in the new communications paradigm must be found; ways that leave no possibility of control by political partisans. Such ways are possible and, given the ravages of the new media age, imperative.

Source: It’s not the economy, stupid. It’s the media

David: Les pommes québécoises et les oranges suisses [immigration], Yakabuski: In Quebec, immigration takes centre stage again on the campaign trail

More on Quebec election immigration debates, starting with Michel Davidd:

François Legault a cette fâcheuse habitude de prendre des raccourcis intellectuels qui déforment la réalité à sa convenance, comme il le fait presque quotidiennement dans le dossier du troisième lien.

Pour justifier sa décision de limiter le nombre d’immigrants à 50 000 par année alors que le gouvernement Trudeau prévoit en accueillir jusqu’à 450 000 pour l’ensemble du Canada, le chef de la CAQ a fait valoir les avantages des petits pays comme la Suisse et les États scandinaves.

Personne ne doute de leur extraordinaire réussite dans une multitude de domaines où une population plus nombreuse peut compliquer les choses. Il est clair que la taille n’est aucunement un gage de richesse ou de qualité de vie.

M. Legault sait cependant très bien qu’il compare des pommes et des oranges quand il établit un parallèle entre des États qui détiennent tous les attributs de la souveraineté et une simple province dont les pouvoirs sont limités, notamment en matière d’immigration. Que leur voisin allemand ouvre les vannes de l’immigration n’empêche en rien la Suisse ou le Danemark de fixer leurs propres règles sans provoquer chez eux un quelconque déséquilibre démographique ou politique.

Il va de soi qu’une explosion du nombre d’immigrants au Canada anglais, alors que le Québec choisit de le limiter, ne peut qu’affaiblir son poids au sein de la fédération et rendre encore plus difficile sa capacité d’affirmer sa différence.

Et suivre le mouvement canadien, ce qui imposerait au Québec d’accueillir 100 000 immigrants par année, compromettrait encore plus sûrement son caractère français, dont les chiffres du dernier recensement ont encore démontré la fragilité.
* * * * * 
Même dans un État souverain, la capacité d’intégration des nouveaux arrivants a ses limites. En avril dernier, la première ministre suédoise, Magdalena Andersson, déclarait que son pays « n’avait pas réussi à intégrer les nombreux immigrés qu’il a accueillis au cours des deux dernières décennies, ce qui a donné naissance à des sociétés parallèles et à la violence des gangs ».

Issue du Parti social-démocrate, Mme Andersson n’est pourtant pas une politicienne de droite adepte de la théorie complotiste du « grand remplacement ». La Suède s’est montrée très généreuse — peut-être trop — lors de la crise migratoire de 2015, en étant le pays européen à accueillir le plus grand nombre de migrants par habitant. « Nous allons devoir revoir nos vérités antérieures et prendre des décisions difficiles », a relevé la première ministre.

Le Québec n’est évidemment pas seul à tenter de concilier le désir de préserver son identité et la nécessité de répondre aux besoins du marché du travail. Au
Danemark, également dirigé par une première ministre sociale-démocrate, Mette Frederiksen, une politique migratoire très restrictive se traduit par un taux de chômage très bas et un manque criant de main-d’oeuvre.
* * * * * 
S’il est difficile pour un État souverain de trouver le juste équilibre, cela devient pratiquement impossible pour le gouvernement qui ne dispose pas de tous les éléments pour résoudre l’équation.

Il y a quelque chose de surréaliste dans le débat sur les seuils d’immigration auquel la présente campagne électorale donne lieu. Chaque parti semble tirer un chiffre de son chapeau, bien qu’il n’ait aucun pouvoir sur la sélection de la moitié de ceux qu’il compte accueillir et ne soit pas en mesure d’évaluer la capacité d’intégration de la société québécoise.

Au-delà de la « compatibilité civilisationnelle » évoquée par le Parti conservateur du Québec, il va de soi qu’un plus grand nombre de personnes exige plus de logements, de places en garderie, de travailleurs de la santé, d’enseignants, etc. Ce qui exige précisément de disposer de tous les outils nécessaires.

Le rapatriement des pouvoirs en matière d’immigration est la seule réclamation commune aux cinq partis, qu’ils soient fédéralistes ou souverainistes. Mais le refus d’Ottawa demeure toujours aussi catégorique.

Jean Charest avait espéré que Stephen Harper fasse preuve d’ouverture. François Legault avait misé sans trop y croire sur Andrew Scheer, puis sur Erin O’Toole. S’il devient premier ministre, Éric Duhaime se fait fort de convaincre Pierre Poilievre et ses homologues conservateurs au Canada anglais. Cela demeure bien hypothétique, c’est le moins qu’on puisse dire.

De passage à la table éditoriale du Devoir, mardi, le chef conservateur a proposé une démarche commune de tous les partis représentés à l’Assemblée nationale, ce qui apparaît déjà plus plausible, sans toutefois offrir la moindre garantie de succès.

Depuis le début de la campagne, M. Legault n’a pas reparlé de la grande conversation nationale sur l’immigration qu’il avait évoquée au printemps dernier sans en préciser la forme, mais il faudra bien faire quelque chose. Si cet exercice pouvait simplement permettre de séparer les pommes et les oranges, ce serait déjà quelque chose.

Source: Les pommes québécoises et les oranges suisses

And from the Globe’s Yakabuski, a good overview:

It wouldn’t be an election campaign in Quebec without a debate about immigration.

Elsewhere in the country, elections come and go without much talk about immigration. A broad consensus exists on the topic across the political spectrum and political parties rarely, if ever, seek to differentiate themselves on the issue. That, it seems, is the Canadian way.

In Quebec, however, immigration has become a hot-button issue that features prominently in party platforms. The issue played a determining role in the 2018 campaign as the Coalition Avenir Québec’s signature promise to slash the number of newcomers the province accepts each year propelled it to victory over the Quebec Liberal Party. Under then-premier Philippe Couillard, the Liberals had set an annual target of 60,000 permanent residents; the CAQ, under François Legault, vowed to cut the number to 40,000. It crushed the Liberals.

Within a couple of years, though, the CAQ government increased its annual target for new permanent residents – to 50,000 – and oversaw an explosion in temporary foreign workers to help alleviate a severe labour shortage amid a clamouring for employees from the business sector. The somewhat ironic result is that Quebec has seen a greater influx of foreigners under the CAQ – to more than 93,000 in 2019 and 100,000 expected this year – than it ever did under the Liberals. Proof that there is a lot more than meets the eye on the immigration file.

The nuances get lost on the campaign trail, however, as the parties once again go at each other over immigration levels in advance of the Oct. 3 provincial election.

Mr. Legault maintains that the CAQ’s 50,000 cap on permanent residents represents the number of newcomers the province can integrate each year without threatening its French character. On Monday, he conceded that Quebec’s population is destined to continue to decline as a share of the Canadian population as Ottawa boosts national immigration targets to 450,000 permanent residents in 2024. But that is the price Quebec must pay to remain an island of French in North America.

Besides, small is beautiful. “Switzerland is an extraordinarily rich, and extraordinarily dynamic, small country,” Mr. Legault said. “Being big might be nice, but what’s important is having a [high] quality of life for the people who live in Quebec.”

But maintaining Quebeckers’ quality of life will become an increasing challenge as the province’s working-age population shrinks and the proportion of seniors rises to 24.8 per cent in 2030 from 20.3 per cent in 2021, according to the Quebec Finance Ministry’s own projections. With a population aging faster than the rest of the country outside Atlantic Canada, future economic growth will be severely handicapped.

That reality has not stopped the sovereigntist Parti Québécois from vowing to cut immigration levels further – to 35,000 permanent residents annually, or less than 8 per cent of the Canadian total – if it wins on Oct. 3. At that rate, Quebec’s share of Canada’s population (which now stands at 22.5 per cent) would likely plummet even more rapidly than it is forecast to fall under Statistics Canada’s most recent projections, which show it falling to 19.8 per cent by 2043.

To back up his plan, Parti Québécois leader Paul St-Pierre Plamondon has referred to a study produced this year for the Quebec Ministry of Immigration by economist Pierre Fortin that disputes the argument that higher immigration levels are needed to address labour shortages as “a big fallacy,” since an influx of newcomers creates demand in the economy that serves to exacerbate shortages for workers, housing and health care.

Prof. Fortin’s study is especially critical of Ottawa’s immigration targets, arguing they will lead to “bureaucratic congestion and confusion,” produce scarce economic benefits, and increase the “social risk of stoking xenophobia and encouraging a rejection of immigration.”

Under leader Dominique Anglade, the Liberals are proposing to boost the number of permanent residents Quebec accepts to 70,000 in 2023. It would determine immigration levels beyond that year in conjunction with the province’s 17 regions in a bid to get more newcomers to locate outside the greater Montreal area.

The far-left Québec Solidaire has adopted the most ambitious immigration targets of all the parties, promising to welcome up to 80,000 permanent residents to the province annually. That would still not be enough for Quebec’s population growth to keep pace with the rest of Canada, but the figure clearly sets QS apart as the most unabashedly pro-immigration party in this election campaign.

When the CAQ leader challenged QS co-spokesperson (and de facto leader) Gabriel Nadeau-Dubois to explain how his party would slow the decline of French in Quebec with such high immigration levels, he responded with a zinger: “The difference between Mr. Legault and me is that he points fingers and I open my arms.”

Source: Opinion: In Quebec, immigration takes centre stage again on the campaign trail

Patient satisfaction surveys fail to track how well USA hospitals treat people of color

Of interest:

Each day, thousands of patients get a call or letter after being discharged from U.S. hospitals. How did their stay go? How clean and quiet was the room? How often did nurses and doctors treat them with courtesy and respect?

The questions focus on what might be termed the standard customer satisfaction aspects of a medical stay, as hospitals increasingly view patients as consumers who can take their business elsewhere.

But other crucial questions are absent from these ubiquitous surveys, whose results influence how much hospitals get paid by insurers: They do not poll patients on whether they’ve experienced discrimination during their treatment, a common complaint of diverse patient populations.

Likewise, they fail to ask diverse groups of patients whether they’ve received culturally competent care.

And some researchers say that’s a major oversight.

Kevin Nguyen, a health services researcher at Brown University School of Public Health, who parsed data collected from the government-mandated national surveys in new ways, found that — underneath the surface — they spoke to racial and ethnic inequities in care.

Digging deep, Nguyen studied whether patients in one Medicaid managed-care plan from ethnic minority groups received the same care as their white peers. He examined four areas: access to needed care, access to a personal doctor, timely access to a checkup or routine care, and timely access to specialty care.

“This was pretty universal across races. So Black beneficiaries; Asian American, Native Hawaiian, and Pacific Islander beneficiaries; and Hispanic or Latino or Latinx/Latine beneficiaries reported worse experiences across the four measures,” he said.

Nguyen said that the surveys commonly used by hospitals (called Consumer Assessment of Healthcare Providers and Systems, or CAHPS) could be far more useful if they were able to go one layer deeper — for example, asking why it was more difficult to get timely care, or why they don’t have a personal doctor.

It would also be more helpful if CMS publicly posted not just the aggregate patient experience scores, but also showed how those scores varied by respondents’ race, ethnicity, and preferred language.

Such data can help discover whether a hospital or health insurance plan is meeting the needs of all versus only some patients. Nguyen did not study responses of LGBTQ+ individuals or, for example, whether people received worse care because they were obese.

Hospital surveys — and how to game them — has become big business

The health care provider surveys are required by the federal government for many health care facilities, and the hospital version of it is required for most acute care hospitals. Low scores can induce financial penalties, and hospitals reap financial rewards for improving scores or exceeding those of their peers.

The CAHPS Hospital Survey, known as HCAHPS, has been around for more than 15 years. The results are publicly reported by the Centers for Medicare & Medicaid Services to give patients a way to compare hospitals, and to give hospitals incentive to improve care and services. Patient experience is just one thing the federal government publicly measures; readmissions and deaths from conditions including heart attacks and treatable surgery complications are among the others.

Dr. Meena Seshamani, director of the Center for Medicare, said that patients in the U.S. seem to be growing more satisfied with their care:

“We have seen significant improvements in the HCAHPS scores over time,” she said in a written statement, noting, for example, that the percentage of patients nationally who said their nurses “always” communicated well rose from 74% in 2009 to 81% in 2020.

But for as long as these surveys have been around, doubts about what they really capture have persisted. Patient experience surveys have become big business, with companies marketing methods to boost scores. Researchers have questioned whetherthe emphasis on patient satisfaction — and the financial carrots and sticks tied to them — have led to better care. And they have long suspected institutions can “teach to the test” by training staff to cue patients to respond in a certain way.

National studies have found the link between patient satisfaction and health outcomes is tenuous at best. Some of the more critical research has concluded that “good ratings depend more on manipulable patient perceptions than on good medicine,” citing evidence that health professionals were motivated to respond to patients’ requests rather than prioritize what was best from a care standpoint, when they were in conflict.

Hospitals have also scripted how nurses should speak to patients to boost their satisfaction scores. For example, some were instructed to cue patients to say their room was quiet by making sure to say out loud, “I am closing the door and turning out the lights to keep the hospital quiet at night.”

A new push to survey hospitals about discrimination

About a decade ago, Robert Weech-Maldonado, a health services researcher at the University of Alabama-Birmingham, helped develop a new module to add to the HCAHPS survey “dealing with things like experiences with discrimination, issues of trust.” Specifically, it asked patients how often they’d been treated unfairly due to characteristics like race or ethnicity, the type of health plan they had (or if they lacked insurance), or how well they spoke English.

It also asked patients if they felt they could trust the provider with their medical care. The goal, he said, was for that data to be publicly reported, so patients could use it.

Some of the questions made it into an optional bit of the HCAHPS survey — including questions on how often staffers were condescending or rude, and how often patients felt the staff cared about them as a person — but CMS doesn’t track how many hospitals use them, or how they use the results. And though HCAHPS asks respondents about their race, ethnicity and language spoken at home, CMS does not post that data on its public patient website, nor does it show how patients of various identities responded compared to others.

Without wider use of explicit questions about discrimination, Dr. Jose Figueroa, an assistant professor of health policy and management at the Harvard School of Public Health, doubts HCAHPS data alone would “tell you whether or not you have a racist system” — especially given the surveys’ slumping response rates.

One exciting development, he said, lies with the emerging ability to analyze open-ended (rather than multiple-choice) responses through what’s called natural language processing, which uses artificial intelligence to analyze the sentiments people express in written or spoken statements as an addendum to the multiple-choice surveys.

One study analyzing hospital reviews on Yelp identified characteristics patients think are important but aren’t captured by HCAHPS questions — like how caring and comforting staff members were, and the billing experience. And a study out this yearin the journal Health Affairs used the method to discover that providers at one medical center were much more likely to use negative words when describing Black patients compared with their white counterparts.

“It’s simple, but if used in the right way can really help health systems and hospitals figure out whether they need to work on issues of racism within them,” said Figueroa.

Press Ganey Associates, a company that a large number of U.S. hospitals pay to administer these surveys, is also exploring this idea. Dr. Tejal Gandhi leads a projectthere that, among other things, aims to use artificial intelligence to probe patients’ comments for signs of inequities.

“It’s still pretty early days,” Gandhi said, adding, “With what’s gone on with the pandemic, and with social justice issues, and all those things over the last couple of years, there’s just been a much greater interest in this topic area.”

Direct outreach to improve cultural competence

Some hospitals, though, have taken the tried-and-true route to understanding how to better meet patients’ needs: talking to them.

Dr. Monica Federico, a pediatric pulmonologist at the University of Colorado School of Medicine and Children’s Hospital Colorado in Denver, started an asthma program at the hospital several years ago. About a fifth of its appointments proved no-shows. The team needed something more granular than patient satisfaction data to understand why.

“We identified patients who had been in the hospital for asthma, and we called them, and we asked them, you know, ‘Hey, you have an appointment in the asthma clinic coming up. Are there any barriers to you being able to come?’ And we tried to understand what those were,” said Federico.

At the time, she was one of the only Spanish-speaking providers in an area where pediatric asthma disproportionately affects Latino residents. (Patients also cited problems with transportation and inconvenient clinic hours.)

After making several changes, including extending the clinic’s hours into the evening, the no-show appointment rate nearly halved.

Patient satisfaction surveys are embedded in American health care culture and are likely here to stay. But CMS is now making tentative efforts in surveys to address the issues that were previously overlooked: As of this summer, it is testing a question for a subset of patients 65 and older that would explicitly ask if anyone from a clinic, emergency room, or doctor’s office treated them “in an unfair or insensitive way” because of characteristics including race, ethnicity, culture, or sexual orientation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Source: Patient satisfaction surveys fail to track how well hospitals treat people of color